Gracilis Muscle Flap Transposition for Management of Perineal Fistulas - A Medical Center Experience

利用帶蒂股薄肌肌肉皮瓣來治療會陰廔管－醫學中心的臨床經驗

吳卓翰(Cho-Han Wu) ； 陳宏基(Hung-Chi Chen) ； 李宗勳(Tzong-Shiun Li) ； 施秉庚(Pin-Keng Shih)

《臺灣整形外科醫學會雜誌》 28卷3期 (2019/09) Pp. 179-187

摘要

Background: Management of perineal fistulas can be a challenging problem. The pedicled gracilis muscle is most commonly used in the reconstruction of perineal fistulas with high rates of healing and lower morbidity of the donor site. Aim and Objectives: To report our experience in the management of perineal fistulas with pedicled gracilis muscle flap and to review previous studies' management methods. Materials and Methods: We performed a retrospective chart review of 11 patients (8 males, 3 females) treated for perineal fistulas from June 2008 to December 2013. The perineal fistulas consisted of complex anal cutaneous (3 cases), complex anal sinus (2 cases), traumatic (2 cases), rectovaginal (2 cases), rectourethral (1 case), and vesicovaginal (1 case) fistulas. Underlying diseases were noted only in cases with rectovaginal or vesicovaginal fistulas (3 patients with cervical cancer receiving combined chemoradiotherapy [CCRT]). No anal sphincter dysfunction was noted except for 2 cases with traumatic fistulas. Results: The mean age of the patients was 42.8 years (range: 21-68). All patients received a pedicled gracilis flap for reconstruction of their perineal fistulas. No donor site complications were noted. All fistulas healed well after gracilis muscle transposition, but cases with previous trauma experienced anal sphincter incontinence. No perineal fistula recurrence was seen at the 25-month follow-up. Conclusion: Pedicled gracilis muscle flap is an ideal and effective option for covering perineal fistulas. However, extra training, including biofeedback, is necessary for patients with fistulas and anal dysfunction.

關鍵字

perineal fistulas ； pedicled gracilis muscle flap

並列摘要

背景：會陰廔管的治療對外科醫師來說一直充滿挑戰，帶蒂股薄肌肌肉皮瓣來治療會陰廔管是目前很常見的方法。目的及目標：回顧文獻與分享醫學中心的治療經驗。材料及方法：我們蒐集2008年到2013年利用帶蒂股薄肌肌肉皮瓣來治療會陰廔管的案例做回溯性研究。結果：總共有11位病人，其中男性有8位，女性3位。會陰廔管的分類則有3位複雜型肛門皮膚廔管，2位複雜型肛門竇廔管，2位創傷性廔管，2位直腸陰道廔管，1位直腸尿道廔管與1位膀胱陰道廔管；病人平均年齡是42.8歲，平均追蹤時間是25個月，所有的病人供皮區都沒有術後併發症，且利用帶蒂股薄肌肌肉皮瓣治療會陰廔管的病患除了創傷造成廔管的病人有肛門括約肌失禁的問題外，其他病人都恢復良好。結論：利用帶蒂股薄肌肌肉皮瓣來治療會陰廔管是個很有效的方法，但是對於會陰廔管同時合併有肛門失禁問題的病人，則需要額外的生物回饋訓練。